Minimal deviation adenocarcinoma ("adenoma malignum") of the cervix: a reappraisal

Five cases of so-called "adenoma malignum" of the cervix are presented. This term has been used to describe an extremely well-differentiated adenocarcinoma characterized histologically be distorted and architecturally irregular endocervical glands which penetrate deeply into the wall of the cervix, but without more than minimal and focal evidence of gland cell stratification, anaplasia, or mitotic activity. Despite this innocuour histologic appearance, these tumors have classically been thought to be clinically highly malignant, with an almost invariably rapid lethal outcome. This discrepancy between the histology and behavior has been presented as justification for the otherwise paradoxical name, "adenoma malignum". In the present series, all patients were treated with modern radiotherapeutic techniques, and four of the five are long-term survivors. Of the patients in the literature who died after rapid dissemination, none received treatment with acceptable radiotherapeutic techniques. Thus, we believe that with proper therapy this tumor is no more malignant than one would expect for a highly differentiated adenocarcinoma, and we suggest that the name, "adenoma malignum," be replaced by "minimal deviation adenocarcinoma of the cervix."